The obesity experts with their bariatric surgery are big players in the market in health care. Where will all the money be channeled? I can't help feeling very negative about surgery that simply makes it really hard to eat, but that only produces weight loss because the person is eating less, which could be done without surgery. Just eat less! That would be free. That would save money. But so many people cannot do that.

107 comments:

I'm of two minds for this.One, self-control is hard. Really hard.Two, how is this different from proscribing a surgery instead of a pill? Obama has used examples of doctors using expensive treatments to line their own pockets instead of proscribing more cost-effective treatments. Wouldn't this fall under the same line of reasoning?Couldn't they just proscribe appetite suppressants instead?

Many health issues, like obesity and depression, are due to people living lives they are not happy with. Makes more sense to me to change your lifestyle instead of stapling your stomach or taking anti-depressants.

It seems to me that even with bariatric surgery and a reduced capacity to eat as much at a sitting, it would be quite possible to eat in a fashion that aggravates diabetes. Consider, for example, what a single bagel contains in terms of carbohydrates, its glycemic index, and what it can ("can" because it depends on the individual, of course) do in terms of blood sugar and other metabolic issues.

I, too, am concerned about the notion of bariatric surgery as a realistic part of diabetes treatment, at least in the majority of cases.

I know a woman who underwent stapling last summer for weight loss. She's been in and out the hospital ever since and has racked up over $200,000 in medical bills due to complications. This is NOT a risk-free alternative.

But once approved as an acceptable method under Obamacare, we'll have the privilege of paying for everyone to choose this high-cost route rather than self-moderation of diet.

The interesting part of this is that the bariatric surgeries seem to have an effect on diabetes, even though there is no obvious mechanism that would connect something physiologically done to the stomach to an endocrinological disorder involving the pancreas.

Figuring out how the two are connected could very well suggest a way of getting the same effect on diabetes patients without having to do the bariatric procedures. That could be a BIG deal.

IF it turns out that following a medical regimen for Type 2 diabetes to the letter STILL is not likely to lead to remission (for some as-yet-unidentified physiological reason), and bariatric surgery will in the long run reduce that person's medical problems and costs, then I think the surgery should be a viable option.

IF, OTOH, the problem is that patients WON'T follow their medical regimens, and THAT is what is leading to lack of remission, then surgery should be WAY DOWN the list.

Bariatric surgery can be very risky and is currently reserved for patients who are severely obese and who pass a pretty intense vetting process. Diabetes is not the only side effect of obesity. Increased risk for cardiovascular disease and hypertension/stroke are additional side effects that may preclude a person from surgery.

I think Amexpat is on the right track. Addressing emotional/mental issues underlying many cases of morbid obesity would probably have the best longterm outcome.

So many cases of type II diabetes (and other cardiovascular/metabolic diseases) are a matter of simple (but not easy) lifestyle changes. Yet this area is a HUGE industry, between diet and exercise programs, supplements, pharmaceuticals and surgeries. Huge.

It is, on the surface, mind-boggling -- we know how to prevent most cases of Type II diabetes and cardiovascular and metabolic diseases. It's simple stuff. The answer has to be emotional/mental. How does a person continually and deliberately choose illness over health, to the point where their last, best hope is drastic surgery that leads to a plethora of additional health issues?

As already stated..>Overeating, lack of exercise and eating the wrong things to cause Type 2 diabetes (not Type 1) is a lifestyle choice. As my daughter might say: you did it to yourself.

It takes years and years of self abuse to get to that condition where bariatric surgery is considered. Your lack of self control should not be a medical procedure that costs everyone else money (reflected in higher insurance premiums for the group).

My husband was diagonsed Type 2 over 10 years ago and it is now under control. We have had to change our lifestyle and way of eating. Was it fun? Nope. Do we backslide sometimes. Heck yes.

A significant percentage of bariatric patients regain their weight eventually. I have had many who end up right back with their diabetes. The ones who do the best are the ones who keep going to support classes and follow-ups with their surgeon and nutritionist after the surgery. The surgery just forces a lifestyle change (in addition to life-long nutritional malabsorption and all its attendant problems) and it gives a quick jumpstart to weight loss that people find gratifying.

I have to think that going to Weight Watchers would be just as effective not to mention safer and healthier - though it would take longer to achieve the weight loss.

N said: Bariatric surgery can be very risky and is currently reserved for patients who are severely obese and who pass a pretty intense vetting process.

The vetting process actually varies widely by locality and doctors. In some places, it's very intense, but in others, you maybe have to go to a single counseling session and fill out a form. (I used to process Short Term Disability claims, so we saw the records from these procedures a lot.)

I used to work with an overweight woman who constantly bragged that she never had and never would go on a diet, who very suddenly had bariatric surgery. She had some counseling, but it was minimal, and she was never pushed to try anything else (or at least, she lied about having tried other things).

Low carb - anyone with weight problems should look into it. The problem with diets is most do not understand the role of hormones. With low carb, you eat a diet which can regulate your hormones and thus your appetite.

Of course, we see what harm will come from Obamacare when you consider that healthcare will be determined by lobbying, not rational choice. The stomach staple crowd will get X amount of dollars to subsidize they craft, come hell or high water, if they convince the govment their procedure actually works. This will come at the expense of other methods which actually do work getting no money, and thus no patients.

That's unfortunate to hear, Lyssa. What's also unfortunate is that the people who are the most cavalier about this procedure are probably the most likely to sue when something goes wrong.

I guess I'm not _that_ surprised, though, because it seems to me that someone who would seek out surgery as an easy way out or for primarily superficial reasons isn't really concerned about long-term health. They're looking for instant gratification.

But I'm completely surgery-averse myself. To me, it's always the absolutely last option, and as I get older, death is probably going to look like a better option in certain circumstances.

The one woman I knew who ultimately had bariatric surgery was one of those people who seek attention via their health problems. She, too, had re-gained most of her weight and subsequent health issues within a few years.

I wonder if the payoff for being unhealthy is greater for her in the long run, and for others who define themselves through their illnesses and health issues.

Many health insurance companies used to deny barbaric surgery because it was considered cosmetic surgery, they have since reversed their stance on this because they have realized the huge savings in medical costs do to obesity realted conditions and especially diabetes.

Before one gets diabetes they have what is called Metabolic Syndrome. Obesity and the causes of obesity is far more complicated than simply overeating.

Part of the reason barbaric surgery works is because of the fact the patient can't eat as much, that's the simple part, the other reason is that the omentum has also been reduced in size.

There is a connection between the omentum and diabetes to make it simple. There are surgeons who have found that reducing the size of the omentum without reducing the size of the stomach, also has a positive effect on diabetes.

To simply say eat less to a person who has this cascade of metabolic disasters going on in their bodies is rediculous.

My only caveat, based on both personal experience and anecdotal evidence, is that extreme low-carb (or "paleo") diets are not without issues either.

I tried it and had some pretty scary side effects and then found out that they were not uncommon among women of, ahem, a certain age.

Let's just say I didn't make it all the way to menopause to start getting periods again because of a diet, thanks. Yes, low-carb diets impact hormones, but extreme low-carb diets impact them extremely.

The Mediterranean-style diets are a better, more balanced approach, at least for me.

And why do you think that is? If it were easy to choose differently, they would. Easy-peasy, right? Years of conditioning to get to where they now find themselves, for most, will take many years of re-training, re-learning and support to change their behaviors. As someone here has mentioned, those who have had the surgery, along with ongoing support have the best chances of succeeding. So, I don’t out and out dismiss the surgery, as our culture does have a propensity to look for the easiest, softest way for a cure. Willpower alone won’t cut it, but ongoing self-care, perhaps, with surgical assist provides a better chance.

This story is outrageous, carbohydrate restriction for the treatment of Type 2 Diabetes is well documented in medical literature and from clinical experience as safe and effective. However it goes against the low fat/whole grains promoting conventional wisdom. Ignoring effective lifestyle changes and promoting surgery really should be treated as malpractice, but sadly it won't.

Yep, I've seen diabetes cured almost immediately after the bariatric surgery. I've also seen how those little bitty ice cream sandwiches are just the right size to eat without causing distress to the new itty bitty stomach. Cookies, too. And still, blood sugar levels are normal.

I've also seen how vitamin D is very hard to manage after bariatric surgery. Isn't evidence increasing that this vitamin/hormone has a greater than previously believed impact on our health?

Until the early 1960's doctors knew that a low carb diet was needed to treat diabetes. You can find research going back to the late 1800's that substantiated this. We've been badly misled about nutritional health during the last 40+ years.

N, I have a friend, a fellow nurse I worked with for many years, strict vegetarian, diagnosed with diabetes last year.

I realize this is anecdotal evidence, but it stands to reason that if one ingests high glycemic foods such as starchy foods, rice, beans, potatoes, bread and one has moved into Metabolic Syndrome, that person will be as at risk for Diabetes, if not more so than one who eats foods that do not affect insulin levels to the same degree.

Long term levels of elevated insulin helps create Metabolic Syndrome ( genetics plays a role too). Reduce the types of food that cause this scenario of chronic elevated insulin, insulin resistance, pre diabetes, then on to full blown diabetes, then one can avoid one of the most devastating conditions caused by the Standard American Diet.

"Low carb - anyone with weight problems should look into it. The problem with diets is most do not understand the role of hormones. With low carb, you eat a diet which can regulate your hormones and thus your appetite."

I've only been on my low-carb regimen about a week and am amazed at the lack of yo-yo-ing hunger and the increased energy and spirits.

AllieOop, it does make sense that a lot of "white" carbs are bad, but I think it's reasonable to eat certain types of carbs -- veggies, some fruit, a small amount of whole grains (although too much of even the "good" grains certainly makes me feel bloated and sluggish).

I guess, since I don't have any current health issues, just a family history of breast cancer (at 51, I'm the oldest living woman in my family. Next oldest -- my oldest daughter. All due to breast cancer), I don't feel as compelled to try the stricter versions of any diet, so I'm okay with some carbs. The paleo diet people were touting was so extreme, though, that I can't imagine it was truly that healthy, regardless of the weight loss people were raving about.

I run regularly, and we live in the epicenter of "organic, locally sourced, sustainable" and all that stuff. I love the Mediterranean style -- fish, chicken, maybe a little veal from time to time, veggies, wine. A little more balance seems to work well for me at this age.

Me too for the low carb. The higher protein content and lowering of the 'bad' carbs in our diet has been a big factor in controlling my hubby's diabetes.

We still eat some carbs, but follow the glycemic index and choose those that are unrefined instead of those that spike the blood sugars. Whole grains, brown rice, fresh vegetables and fresh fruit for dessert.

And yes...we do cheat occasionaly with cocktails or a slice of pie. What would life be if you couldn't have pie once in a while :-D

Another vote for low carb diet and execise. Just getting rid of high glycemic index foods makes it much easier to eat right. Use your phone to set an alarm alarm for the next time to eat. Any exercise is good, especially aerobic exercise.

Obviously different people people process food differently, some people are extremely challenged keeping at the right weight and it is not necessarily their fault.

Bob Ellison, yes of course, but some much more than others. The idea is to keep insulin levels steady and low and avoid the big surges and spikes, that cause extreme hunger when levels then plummet, which in turn causes overeating, it's a vicious cycle.

It's interesting to think about the psychology of all this. Particularly the recidivists. I have a good friend who after bariatric surgery discovered that an amazingly gorgeous - I mean model gorgeous - petite little lady had been living under all those pounds. I didn't know her before she lost the weight, so I don't know exactly what life was like for her before. But, it's darn good now. I imagine she won't backslide.

But what about the people who discover they are still average to ugly, still don't really care to do the sports and activities their new bodies allow and don't really gain any immediate benefits from the weight loss? All they have to look forward to is a nice, long life of denying the foods they want to indulge in. What a bummer.

N, may I recommend a book? It's called Wheat Belly written by a Milwaukee cardiologist, William Davis. Just because the grain is digested more slowly in the GI system does not mean that it doesn't cause the same devastation. It's an eye opening look at wheat and what has happened to us as a result of eating it, whole grain or white.

Non starchy vegetables and low glycemic fruit can be eaten on a low carb diet, and feel free to use saturated fats, they are not the cause of arteriosclerosis. Fructose is more devastating , your liver metabolizes it and sends it into your bloodstream as LDL.

Jennifer, many who yearn to lose weight only want to experience the feeling of being thin. In a process called hedonistic adaption (you know I must be smart to know a term like that!) you quickly get used to new experiences and take them for granted, and look for new ones to take their place.

In this way, many who work, sweat, get surgery, and so forth to get thin and love the feeling quickly tire of it and look for something new to amuse them. Since food is very amusing indeed, they generally turn back to that quick fun indulgence and thereby regain the weight they lost.

Yes, yo-yo dieting is programed into our very soul. Being aware of the human condition can help you shape your desires, but you can never overcome the human condition completely.

Once your sugar regulation mechanism is altered by all the added weight, I think it's much harder to stop eating. Like many others, my cravings pretty much stopped on the South Beach Diet. I've been on it five years and love it. I lost 12 pounds and have kept it off. I think the medical/govt complex is resisting this truth full force.

So I would force them on a low carb diet in the hospital to transition them, then maybe surgery if it's still too hard to lose weight. That's my medical opinion! :)

If only it was as simple as the "stop eating so much" crowd makes it sound. Althouse gets enraged over the bias shown on the issue of gay marriage (calling people "clowns" for example), but has no problem generalizing that all obese people are not only eating too much, but deliberately choosing to do so. In a way, it is like me saying gay people should choose to stop being so gay. It is all much more complex than such an ignorant and stupid statement.

Deborah - she did say "Just eat less!" I think this reflects a stereotypical attitude towards obese people. I have yet to meet an obese person that wants to be obese.

Many obese people have an extreme desire to be a healthy weight. But that extreme desire is useless with all the misinformation that is out there about what is actually causing obesity. Countless obese people loose significant weight, only to gain it all back. Very few are just lacking the will power it takes. No sane person keeps trying to do something over and over again, when it never works.

Just eating less never works in the long term. Even lab rats with a genetic disposition for obesity that are fed a low calorie diet are able to stay obese unless they are literally starved. Biological, no person can drive their body to starvation to loose weight - at least not for a long period. The only way to loose weight long term is to shut off the terrible insulin spiking cycle - eating because you are low energy, getting a rush of insulin and feeling momentarily gratified until you blood sugar drops, causing you to eat again. Getting past this cycle can only be done with a low carb diet. 99% of the time, it is the only thing that works long term for people that are inclined to be obese. This was known throughout the medical community until the last 40 years, when they somehow forgot it.

Be careful with Flax if you are hypothyroid. Flax seeds as well as Soy are goitrogenic. A better source of fats are animal fats. I know it's hard to wrap your heads around that one after all the misinformation we've been getting for the last 30 years.

RalphL, inflammatory bowel disease is associated with increased incidences of Colo-rectal cancer. As well as smoking and genetics. Wheat irritates the lining of the bowel to the degree that it causes leaky gut syndrome, which causes another whole cascade of conditions.

Fiber is overrated. Eat enough saturated fat, drink enough water, and you won't ever experience any issues regarding regularity. People with IBS cannot tolerate fiber, fiber can turn into a bezoar if enough water isn't consumed. Many folks are chronically dehydrated.

You can get sufficient fiber from eating vegetables and fruit. What did the cavemen do? Drink Metamucil?

The Taubes book is a great way to understand the insulin connection, he makes it easy to understand.

Actually, there's not as much fiber in fruit as one might think and most fruit is high in sugars which trigger insulin response. Ground flax has 4 grams of fiber in a 2 tablespoon serving plus it is low in sugar and high in other essential nutrients like Omega-3.

By the way, as much as I have enjoyed beer over the course of my adult life, there is a reason it's called "beer belly". Beer is one of the most highly refined high carbohydrate foods available. If you really insist on having alcohol, I recommend a single glass Cabernet Sauvignon.

I've been to the ER more than most, on my behalf and on others', and recently I asked an ER doc whether I had handled a situation incorrectly and how I could have avoided it. He graciously said I had done OK and pointed at the IV bags of saline and said "that's the biggest medical miracle of our lifetimes".

Water, just water. And maybe just a tiny bit of salt and sugar. Saves lives. Drink it and you might escape the ER.

Meade, true. A 12-ounce pale ale equals 1.9 units of insulin for me, and damned fast. That's a carb-load for sure. I carry Skittles in my pocket because I'm Type I, but my experience is that beer works about as fast.

The science on this is overwhelming. The vast majority of people who CAN lose weight, CANNOT keep it off.

I don't think stomach-stapling really solves this problem. I don't think the cure for obesity is near-starvation.

But let's first get rid of the stupid notion that this has to do with willpower, a moral failing on the part of the obese, and more fodder for the purported self-reliant non-RINOs to critique society.

The problem is not how much people eat, it's what people eat. People eat to sate hunger. Unfortunately, some of those choices induce obesity and/or diabetes. Some of those choices are, unfortunately, staples of the American diet, in particular packaged foods and quick-serve restaurant items.

If you can show me where there has been adequate education for American eaters on what to eat and what not to eat to avoid obesity and diabetes, then I'd go along with the implicit tut-tut-tut here. There has not been, however. Quite the reverse.

"If you really insist on having alcohol, I recommend a single glass Cabernet Sauvignon."

See! I've won Meade over to my health regimen.

Also, from the linked old fashioned cure for diabetes: "For forty-eight hours after admission to the hospital the patient is kept on ordinary diet, to determine the severity of his diabetes. Then he is starved, and no food allowed save whiskey and black coffee. The whiskey is given in the coffee: 1 ounce of whiskey every two hours, from 7 a.m. until 7 p.m. This furnishes roughly about 800 calories. The whiskey is not an essential part of the treatment; it merely furnishes a few calories and keeps the patient more comfortable while he is being starved."

Obesity is a national issue, and when young kids start getting type 2 diabetes, it's time to crank up the volume on this NOW.

Many here make fun of Michelle Obama for her efforts at educating young kids and their families about nutrition, but I say, good for her. Her visibility as first lady means that she gets listened to much more than most, and especially by young kids who need this education.

If you learn to eat right as a young child, the greater the chances you can avoid type 2 diabetes as an adult.

There are still sugars in wine and even more in beer. The enzymes used in their making are poisoned by ethanol, with beer yeast being more sensitive than wine. Thus wine ferments a greater portion of its sugars than beer. Distilled spirits of course have mostly just ethanol (not a sugar) and water along with flavorings.

Many here make fun of Michelle Obama for her efforts at educating young kids and their families about nutrition, but I say, good for her.

In my experience, young kids and even teenagers will eat what they want to, despite any outside FLOTUS effect. It's the parents of the kids who have learn and teach their kids. If Michelle Obama connects better to children at risk from lax parenting, then she is a net plus.

I hope that her husband's DoE Secretary realizes that his personal choice and scoldmongering for higher energy prices affects the type and quality of food that people can put in themselves.

Of course, he becomes really present in consecrated bread. You know, Him being the Bread of Life, not the Porterhouse of Life.

Just sayin'.

I'm still not sold on the more extreme versions of the low-carb diets.

One of the biggest problems in the U.S. is portion size. An Olive Garden pasta portion would kill an ox. Also, snacking and soda pop are not something you see much in Europe, or didn't used to see, anyway.

How we respond to certain foods is probably pretty individual. Aren't only about 25% of the population supposed to have some kind of insulin sensitivity? This percentage no doubt benefits greatly from a high protien/low carb diet, while others may or may not.

I think all of us benefit from eating smaller portions of whole, "clean" foods, avoiding snacking and junky, processed foods, soda pop, and all that crap. Movie theatre popcorn is a killer in a bucket, as are those ginormous Starbucks glorified milk shakes, along with all the other mindless ways we consume 1000+ calories at a pop and don't even factor them into our dietary intake for the day.

Those of you who pass negative judgment on the obese need to take a step back.

First, there is nothing you can say to them that they have not said to themselves. Yeah, there are a few who see themselves as "big beautiful people", but only to armor up against what has become nearly the last bastion of outright discrimination in the US.

"But it's their own fault!"

So what if it is? Is that YOUR business?

Is it also your business when people have kids knowing their family genetics are heaped with odds of future breast cancer or heart disease or emotional problems, and then that happens?

Is it your business when women desperate to have children take fertility drugs and have multiples, many with serious health problems?

Is it your business when a mother decides to not abort her child that will be seriously disabled?

Oops sorry, that last one is OK because we HATE abortion here at Althouse.

Look, we all have opinions. I get that. Also remember that too much energy released on your "FAULT lines" is going to cause an earthquake that just might extend to you too.

John Stodder said..."If you can show me where there has been adequate education for American eaters on what to eat and what not to eat to avoid obesity and diabetes, then I'd go along with the implicit tut-tut-tut here. There has not been, however. Quite the reverse."

Too true. Here is a Gary Taubes piece from last year. He doesn't claim to have it all figured out but I do think he's on to something important. We have been miseducated about food, diet, and what makes us fat.

Can't remember the medical doctor who said something like: If it's working, keep it up. If it's not working, stop it. And by all means - stay away from surgeons.

Michelle O should not be telling kids what to eat. Exercise? Okay. But the official govt diet and the free food at schools and the free food stamps to everyone are linked to the increase in obesity.

Go watch Hoop Dreams, made in the early '80s. There is not one fat person in the entire inner city neighborhood in the film. They bought their own food on a budget and so had to care about what they ate.

John Stodder said..."If you can show me where there has been adequate education for American eaters on what to eat and what not to eat to avoid obesity and diabetes, then I'd go along with the implicit tut-tut-tut here. There has not been, however. Quite the reverse."

Sorry, but thats bullshit. That info is out there for the taking for anybody really interested in finding out. I don't see how you could poswsibly write that with a straight face.

The diet that leads to a giant ass is the same one that leads you to Type II Diabetes.

IF you sit on your ass all day, your hobby should not be eating above 2000+ calories a day, because you WILL get fat doing that. That include those Starbuck FatAss Series of candybars in a cup they claim is a coffee drink.

This isn't about "lack of information". Its about lack of will power and shitty eating habits.

I don't snack. I excercise moderately and I get to eat what I want. I am a nice lean bodymass and I don't have these health problems that come from lack of self control when around the fridge.

I get to have real ice creme and other cake and even candy bars ofr dessert because I am not a blimp in training. Put the spoons down in between meals and you'll probably begin to lose weight and get healthier.

I really am not sure Penny, but I do know that SOMEONE is paying for the unisured to get care, because they cannot be turned away for the ER by law.

So whoever is paying will make sure they aren't left holding the bag, so the cost will get passed on to us in the end, figuratively and literally. Businesses will find a way to make a profit, bottom line.

If only it was as simple as the "stop eating so much" crowd makes it sound.

Actually, it is easy. Too many fat people are just overly lazy and use it as an excuse. Too many fattys rationalize their inability to regulate their diet as being "too hard". It's not hard, unless you really don't want to stop being fat.

I know too many people that have lost big weight by doing easy things and kept it off to beleive the "it's too hard" excuse making from people who claim they want to lose weight but can't ever seem to fight off the donuts and other shit that flies into their mouths enexpectedly.

Yea I'm not supportive of the "I'm just a victim of life" bullshit propaganda that the fatass lobby uses to justify their laziness, because now its being used to get more free shit from other people.

It's completely predictable and the fat heads have been prepping the battlesace with drivel like this for years now to justify insurance coverage for uneeded surguries.

As a gastric bypass patient who used to weigh 474 lbs and am down over 200lbs now.....my weight loss was only possible because of the surgery. Over a year of work pre-surgery got me down ~30 lbs. No matter how low my caloric intake was, I could not lose any further weight.

Now, for those of you who wish to continue to bash the obese as "poor choice makers", I will ask that you extend that to people who make "poor choices" such as any sports players, drug addicts, and anyone who makes a lifestyle choice...whether they consciously make it or not.

And let me add this little nugget. The vitriol some of you hold for "fatties" is disgusting. While there are many causes to obesity, there are also many cures based on a person's lifestyle, metabolic rate, and activity level.

To simply and I quote "PUT THE SPOON DOWN. STEP AWAY FROM THE DONUT. QUIT EATING LIKE A PIG." demonstrates the cluelessness you have on this issue.

Again, if you wish to discuss this without vitriol or in a condescending tone...please carry on.

SGT Ted said..."Too many fattys rationalize their inability to regulate their diet as being "too hard". It's not hard, unless you really don't want to stop being fat."

Ted, it must feel so good to live in your black and white world, where people have complete control over the genes they inherited and the food culture they were raised in. What may be just a little exercise of self control to you, might take another person more will power than you have ever had to exercise in your life.

You have obviously never struggled your whole life with obesity. You have not been looked down upon because of the way you look. You don't understand how an obese person desires every day to not be obese. It is not just a "I wish I was skinny" thought. It is a terrible feeling that you are a weak and disgusting individual because you are fat. That is why obese people spend their entire lives trying over and over again to loose weight.

I was one of those obese people. But have finally controlled it for the first time in my life. I had listened to ignorant people like you, as well as doctors, for the past 20 years and couldn't figure out why I couldn't just have enough will power. After all, I graduated at the top of my class in law school, had been a good father and husband, had been successful in my career. I even ran two marathons (still carrying 50 pounds of useless weight). Could you run a marathon carrying a toddler on your back? Obviously, I have a high level of will power, so why couldn't I just have enough will power to not eat so much?

There were times I went weeks on end eating 1500 calories a day and hardly moving the scale. So I would decrease my calories to 1000, starve for a week and break. We are biologically made to not starve ourselves. But to you, people should have enough will power to literally starve their bodies.

Thankfully, I came across the book mentioned by Meade - Why People Get Fat. I learned that it wasn't as simple as calories in vs. calories out. Even lab rats will a genetic makeup to be obese will stay obese when given a very restricted calorie diet. At least until you literally starve them. People who are extremely calorie deprived in cultures around the world are still obese due to the high carb content of the little food they do get.

Even doctors who don't understand the principles in 'Why We Get Fat,' will admit that genes play a significant role. One doctor told me it was 80% genes and 20% diet. That is why several of my friends stay lean eating double the amount of food I do.

It is about so much more than just not eating too much. I ask you to rethink your ignorant comments. I can understand you looking at an obese person and wondering why they don't just eat less. After all, you are coming to the issue with an extreme lack of knowledge about what makes a person fat. But to be so mean and condescending about, just makes you an ass.

A man with a toothache thinks everyone without a toothache is happpy. That's not the way it works. I wish everyone success with their diets, but the trim and the fit also have their difficulties negotiating their passage. Who knows? Maybe obesity literally cushions the blows. Lose weight and have a perfect life. I wish I knew a way of attaining a perfect life.